This bill prohibits health insurance policies, and self-insured governmental and school district health plans, that cover injected or intravenous and oral chemotherapy from requiring the insured to pay a higher copayment, deductible, or coinsurance for oral chemotherapy than is required for injected or intravenous chemotherapy, regardless of the formulation or benefit category determination by the policy or plan. A health insurance policy or self-insured governmental or school district health plan may not comply with that prohibition by increasing the copayment, deductible, or coinsurance for intravenous or injected chemotherapy that is covered under the policy or plan.

The requirements of the bill apply to individual and group health insurance policies, including limited service health organizations, preferred provider plans, defined network plans, and cooperative associations' health care plans; to health care plans, including a self-insured plan, offered by the state to its employees; and to self-insured health plans of a city, town, village, county, or school district.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB300,3,1717632.867Oral and injected chemotherapy.
(1)Definitions. In this section:

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(a) "Chemotherapy" means drugs and biologics that kill cancer cells directly, 19including antineoplastics, biologic response modifiers, hormone therapy, and 20monoclonal antibodies, and that are used to do any of the following:

SB300,4,93(2)Copayment, deductible, or coinsurance requirements; limitations. (a) A 4disability insurance policy that covers injected or intravenous chemotherapy and 5oral chemotherapy, or a self-insured health plan that covers injected or intravenous 6chemotherapy and oral chemotherapy, may not require a higher copayment, 7deductible, or coinsurance amount for oral chemotherapy than it requires for 8injected or intravenous chemotherapy, regardless of the formulation or benefit 9category determination by the policy or plan.

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(b) A disability insurance policy or a self-insured health plan may not comply 11with par. (a) by increasing the copayment, deductible, or coinsurance amount 12required for injected or intravenous chemotherapy that is covered under the policy 13or plan.

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(a) Except as provided in paragraphs (b) and (c), disability insurance policies 17that are issued or renewed, and governmental or school district self-insured health 18plans that are established, extended, modified, or renewed, on the effective date of 19this paragraph.

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(b) Disability insurance policies covering employees who are affected by a 21collective bargaining agreement containing provisions inconsistent with this act 22that are issued or renewed on the earlier of the following:

SB300,4,23231. The day on which the collective bargaining agreement expires.

SB300,4,25242. The day on which the collective bargaining agreement is extended, modified, 25or renewed.

SB300,5,41(c) Governmental or school district self-insured health plans covering 2employees who are affected by a collective bargaining agreement containing 3provisions inconsistent with this act that are established, extended, modified, or 4renewed on the earlier of the following:

SB300,5,551. The day on which the collective bargaining agreement expires.

SB300,5,762. The day on which the collective bargaining agreement is extended, modified, 7or renewed.

SB300,98Section 9.Effective dates. This act takes effect on the day after publication, 9except as follows:

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(1) The treatment of section 632.867 (2) (a) of the statutes takes effect on the 11first day of the 7th month beginning after publication.